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a reduced in-patient stay supports the economic argu- ment for SNB over END [28] . The identification of aberrant drainage patterns is a huge advantage of SNB and will also have application in patients with second primary tumours where a neck dissection has already been performed and drainage has been disturbed. The disadvantage of blanket ipsilateral END is illustrated in the study of pN0 necks treated by END [21] . In this series, the regional recurrence rate of 18% seems high but it is worth noting that in over one- third of patients (39%) recurrence occurred in the contralateral neck. One further advantage of SNB is that because the tissues have not been significantly disturbed, comprehensive salvage surgery is possible if a recurrence is detected promptly. Our results have also shown that the metastasis type (ITC, micrometasis, macrometastasis) was a prognostic value for overall survival. This confirms recent findings [29,30] and may be important for strati- fying personalised treatment in the future. At the present time, SNB is not widely recognised as standard care in early oral and oropharyngeal cancer. However, increasingly it is gaining utility in Europe and in some countries, such as Denmark, it is integrated into the standard care pathway. Data emerging from this study are relevant to the evolving therapeutic use of SNB technique and provide data to support further investigation by prospective randomised trials. The drive towards patient-specific and minimally invasive surgery is further refining the SN technique and we expect that the use of intraoperative 3D navigation [31] , new tracers [32] and fluorescent markers [33] will improve the ease and accuracy of sampling sentinel lymph nodes. SNB potentially offers the solution to the dilemma ’How do you manage the N0 neck?’ Part of this work has been presented by members of the Sentinel European Node Trial (SENT) group at meet- ings of the European Association of Craniomaxillofacial Surgery, The American Head and Neck Society, the European Congress of Pathology, the International Association of Oral and Maxillofacial Surgery, and the British Association of Oral and Maxillofacial Surgeons as well as our annual SENT group meetings, part of the International Symposium on metastasis in head and neck cancer. Presentations of this work

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Conflict of interest statement

The authors confirm that there is no conflict of in- terest in relation to this publication.

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